Current pain and headache reports
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Nonsteroidal anti-inflammatory drugs are the mainstay of migraine treatment for children and adolescents by most primary care physicians. Not all patients respond to these readily available agents. Triptans have been studied in children and adolescents, and there is reasonable evidence to support the use of these agents in these populations. ⋯ Agents such as antidepressants, anticonvulsants, and antihypertensives are commonly used in clinical practice. Safety issues are fairly well understood because of historical use and use for other conditions. Efficacy and optimal dosing have yet to be established for the treatment of migraine in children and adolescents in double-blind, randomized, placebo-controlled trials.
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Post-traumatic headache after craniocerebral trauma is not an uncommon occurrence in children and adolescents. It can occur after mild, moderate, or severe injury. ⋯ In time, the headache and accompanying symptoms gradually resolve over a period of 8 to 12 weeks. However, sometimes it may become chronic, requiring a multidimensional management approach including pharmacologic intervention, physical rehabilitation, and cognitive-behavioral therapy as used in the adult population.
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Headache is a common presenting complaint in the pediatric emergency department. Although the majority of headaches are benign in nature, headache may be secondary to more serious pathology, such as tumor, meningitis, hemorrhage, or brain abscess. A systematic history will elicit the temporal pattern of the headache, guiding the development of an appropriate differential diagnosis. Thorough physical and neurologic examinations will disclose the objective signs that dictate the need for further diagnostic testing.
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Chronic daily headache (CDH) is increasingly recognized as a problem in pediatrics and tertiary pediatric headache care. It is estimated that up to 4% of the adult population has CDH. Many of these are chronic migraine (CM). ⋯ In children, most CDH appears to have migraine features, although it may not completely meet the ICHD-II criteria for migraine or CM. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the secondary headaches or headaches directly attributed to a secondary cause. Treatment and management involve a multidisciplinary approach, including acute therapy for when the headache severity increases (while avoiding medication overuse), preventative therapy to reduce the frequency and impact of the CDH, and biobehavioral therapy to assist with long-term outcome.
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Migraine in the pediatric population remains substantially underdiagnosed and undertreated. The recently revised International Classification of Headache Disorders is a step in the right direction to improve our diagnostic accuracy. This article reviews the practical diagnostic issues related to migraine in the pediatric population.